| NPI | 1609053024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW68953) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW 20763) |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2021-03-10 |